Provider Demographics
NPI:1720173552
Name:GRAY, DONALD JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JASON
Last Name:GRAY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2906
Mailing Address - Country:US
Mailing Address - Phone:513-792-0070
Mailing Address - Fax:513-792-0466
Practice Address - Street 1:6934 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-3821
Practice Address - Country:US
Practice Address - Phone:513-792-0070
Practice Address - Fax:513-792-0466
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2641789Medicaid
OH8585002418002Medicaid
OH000000350968OtherANTHEM BC/BS
OH2641789Medicaid
OH8585002418002Medicaid